Strategic Health Diplomacy initiative
    

In brief:

A new US bipartisan study shows that in developing countries where an American programme has been working since 2003 to address HIV-AIDS:

* Anti-retroviral treatment has been provided to more than 7.7 million men, women, and children, helping to improve health conditions and outcomes in target countries dramatically
* Political instability and violence / terrorism has dropped 40% (vs. 3% in similar countries where the program is not operating)
* Rule of law ratings increased 31% (vs. 7%)
* The US had an average approval rating of 68% (vs. the global average of 46%) and
* Average output per worker increased by a third (vs. stagnant growth)
Citing the PEPFAR program's multi-dimensional benefits, report authors -- former US Senate Majority Leaders Tom Daschle (Democrat) and Bill Frist, (Republican) -- urge US policy-makers to expand "Strategic Health Diplomacy" and point to malaria and hepatitis C among the most promising targets for an expanded US role in global health.

 
Global health programmes offer an effective tool for securing US interests and mitigating foreign threats, according to a new bipartisan report authored by two former US Senate Majority Leaders: Democrat Tom Daschle and Republican Bill Frist.

Published by the Washington DC-based Bipartisan Policy Centre, the study (available at http://bit.ly/1NxehhC), calls for Americans to adopt a larger role fighting disease abroad, citing major secondary strategic, trade and security dividends from humanitarian work to improve global health.

According to the report, healthier populations make for more prosperous and stable societies. When the United States helps improve the health of people in other countries, Americans gain goodwill and strengthen U.S. national security, as exemplified by results of 
the ongoing President's Emergency Plan for AIDS Relief (PEPFAR).

Established by George W. Bush in 2003, Congress approved it with strong bipartisan support and created bilateral aid programs to enhance HIV/AIDS treatment in 15 low-and middle-income target countries. PEPFAR was renewed by Congress in 2008 -- with a near-tripling of its budget -- and again in 2013. PEPFAR now reaches 65 countries worldwide.

PEPFAR's Strategic Impact

USAID, CDC support Thailand HIV Test and Treat program

USAID, CDC support Thailand HIV Test and Treat program

Image by USAID Asia

HIV/AIDS, the 6th leading cause of death worldwide, is a destabilizing force in some of the world's poorest and most vulnerable societies. 

At the turn of the millennium, American leaders recognized that the devastation caused by HIV/AIDS would depress economic development, inhibit good governance and decrease the size and productivity of the workforce conditions that breed instability and conflict. 

With nearly 37 million people affected by HIV/AIDS, the United States responded in 2003 with PEPFAR, the greatest ever example of humanitarian action by a single country.  

PEPFAR's has reduced HIV/AIDS-related mortality and morbidity and rapidly expanded access to anti-retroviral treatments for more than 7.7 million men, women, and children. 

In addition:
  •  
    Studies have shown that PEPFAR has contributed to a positive opinion of the United States in target countries-a finding that holds true across all 12 PEPFAR countries in Sub-Saharan Africa receiving funds since 2003. According to Gallup poll data collected on public opinion of U.S. leadership from 2007 to 2011, PEPFAR countries have had an average approval rating of 68 percent compared with the global average of 46 percent
  • PEPFAR's ability to decrease mortality, morbidity, and the prevalence of HIV/AIDS limited the loss of human capacity. Since PEPFAR's inception, target countries have fared substantially better on socio-economic indices as compared with non-PEPFAR countries in the region. For example, PEPFAR countries improved on United Nations Human Development Index (HDI) scores -- a composite measure of socio-economic development-more quickly than non-PEPFAR countries. Since 2008, PEPFAR countries on average increased their positive HDI rank by more than three points compared with just one point for non-PEPFAR countries.
  • PEPFAR has also played a role in security, stability, and governance. According to World Bank data, since 2004, PEPFAR countries in Sub-Saharan Africa reduced political instability and violent activity by 40 percent compared with only 3 percent among non-PEPFAR countries in the region.
The report says PEPFAR has worked and the United States should do more.

Considerations for Future Strategic Health Diplomacy

In a resource-constrained environment, it is important to select future global health programs that have clear strategic benefits and design them to have the biggest possible impact, according to the report. The PEPFAR study offers six key lessons for designing SHD initiatives:
  • have clear goals and identify policies needed to achieve them
  • address real needs with visible effect
  • be sensitive to local contexts
  • be in it for the long-term
  • build capacity
  • be transparent and accountable
As well, it says, future American SHD programs and initiatives should be selected using three main criteria:
  • prevalence of a disease
  • its treatment potential
  • the strategic value of stricken areas
Says the report:  "As policymakers debate how to engage the world -- and how to secure U.S. interests and mitigate foreign threats under budgetary constraints -- strategic health diplomacy should be considered an effective tool to meet these challenges."

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